Agenda item

The draft Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP) was published on 23 November 2016. This report updates the Board on the progress made since the last update presented in February 2017.

The presentation to the Board will focus on the ‘Our Case for Change’ document published on 24 March 2017 and the emerging service model, particularly proposals in relation to local care.

Discussion

The update on the Kent and Medway Sustainability and Transformation Plan (STP) was introduced by its Programme Director and by the Accountable Officer of NHS Medway Clinical Commissioning Group (CCG). Medway Council’s Head of Communications and Marketing was also in attendance for the item.

The Board was informed that the update provided would need to change slightly due to the purdah period for the forthcoming general election. Consequently, there would not be discussion of the presentation that had been included in the Board papers. It was proposed that this would be added to the agenda for discussion at the Board’s next meeting in June 2017.

The Board was shown an information video in relation to the Medway Model. The key points included in the video were as follows:

·         The Medway Model was vital to enable the NHS locally to meet demand. It was about ensuring that services were integrated and that the right care was provided in the right place to the right person.

·         Collaborative working between GP practices was being piloted with digital transformation being a key aspect as part of the move towards provision of services from 8am to 8pm seven days a week. Digital transformation included the rollout of online appointment booking.

·         Care Navigators would act as co-ordinators of services provided to patients. The Navigators would be part of a multi-disciplinary team.  Two pilots were being planned to enable people to be proactively targeted to help them to stay well and to identify needs before they reached crisis point.

·         Medway CCG was working with the Fire Service to engage with the elderly and frail who were at the most risk of falling within their home. Visits and actions were being undertaken to reduce these risks with the aim being to reduce falls and, therefore, the number of people requiring acute care.

·         The CCG and Medway NHS Foundation Trust were looking at the possibility of setting up clinical hubs where the needs of frail and elderly people could be effectively managed. Six practitioners would be funded by the CCG to develop a frailty specialism.

·         The Medway Time Credit initiative enabled volunteers to receive time credits that could then be redeemed against various leisure activities.

The Board was provided with an overview of the Case for Change document. There were three stages to the Case for Change process. The first stage was the rationale for change (included in the agenda pack) which outlined why changes needed to be made to services. This was intended to detail what changes would be required. The second stage would set out the service models of the proposed changes while the third stage would present more detailed service configuration options ahead of consultation being undertaken.

The Case for Change document had been compiled following extensive engagement between a variety of health bodies, the Council and other partners. A detailed technical document had been produced following this engagement. The document being presented to the Board was a summary of the more detailed document. The Board was invited to comment on the Case for Change and the proposals outlined.

The Board raised a number of points and questions as follows:

Technology enabled houses and Medway Credits: A Member said that the video shown to the Board had not recognised the importance of technology enabled houses and it was disappointing that conversation in relation to this did not appear to be moving forward. In relation to Medway Credits, the Member was concerned that the geographic area in which the trial was taking place was quite small and that development of the scheme had been relatively slow.

The CCG Accountable Officer said she did not have significant concerns in relation to the development of Medway Credits and that work was ongoing to develop the scheme. With regard to technology enabled homes, it was acknowledged that the video had not covered this areas but there were limitations on what could be covered in a short video. Work was being undertaken with the Council and Medway Commercial Group in this area. The STP Programme Director said that promotional videos were also being produced at a Kent and Medway level and noted that there was a digital / technology workstream within the STP. There were four digital roadmap footprints across Kent and Medway that aimed to promote the effective use of technology. 

Engagement Activity: In response to a Board Member who asked about STP engagement plans, the CCG Accountable Officer confirmed that listening events were being planned to take place across Kent and Medway. A series of events would be developed and although the events would not be able to take place until after the general election, plans were currently under development. Another Board Member said that engagement activity needed to make clear the benefits of the changes being proposed. A further Member of the Board emphasised that it was important that the STP was not oversold as this could lead to people having false expectations about service improvements.

GP shortages and careers in the medical profession: A Member commented that GP shortages were caused in part by the difficulty that potential GPs experienced in accessing training. Although this was a national problem, it was particularly significant locally due to the existing shortage of GPs and the number of current GPs who were approaching retirement. Engagement with housing and education services was important.

The Programme Director said that Kent and Medway was one of the largest areas in the country with no medical school. The creation of such a school had a role to play in addressing GP shortages. The provision of collective GP services within a given area and other pooling of GP resources also had a role to play. A number of GP practices were starting to work together in federations or extended primary care teams serving populations of 30,000 to 40,000 with community services and community personnel starting to be based at practices. This would help to free up clinical time. There could be opportunities for these teams to work together to start to take on commissioning budgets.

The Medical Secretary of the Kent Local Medical Committee considered that working in partnership with patients and promoting self care was key to alleviating demand on GP time along with spreading workloads amongst a wider range of care professionals and the establishment of a local medical school. The very notion of a medical school was providing benefit as people were interested and engaged in the idea. This would improve staff morale. Although it would take several years for a medical school to produce its first GPs, there would be other benefits realised more immediately. It was proposed and agreed by the Board that the Dean of Health at the University of Kent, Peter Nicholls, would be invited to a future meeting of the Board to talk about the development of the medical school proposals.

Another Board Member said that given the workforce challenges, the risk rating should be higher than that contained within the report. The Programme Director acknowledged that workforce was a significant challenge facing all local STPs. Supply of staff was an issue which also affected acute providers  and ancillary staff as well as General Practice. The Deputy Director of Children and Adults confirmed that discussion would take place about upgrading the workforce risk rating.

Role of Care Navigators: In response to a question about the role of Care Navigators and whether they were signposting to other providers, such as the third sector, the CCG Accountable Officer advised that there were three types of Care Navigator. The most basic type would support people with one or two medical conditions and would help signpost the individual through the healthcare system. The second level of Care Navigator was for people with more complex needs for which the Navigator would require a health and social care background. This would be funded by the Better Care Fund. The third type of Care Navigator would be Complex Case Managers for people with complex care packages and needs.

Role of Voluntary and Charitable Organisations: A Member requested clarification of the role envisaged of charitable organisations in future healthcare provision and asked how these organisations would be identified. The Programme Director anticipated discussion with the Council around this. It was recognised that the third sector was not currently being fully utilised. This was something that would be considered further by the Kent and Medway Partnership Board. The CCG Accountable Officer added that the Involving Medway project had brought together voluntary sector providers. Voluntary Action had updated a directory of voluntary organisations to ensure that providers were aware of the various services available. A video would be produced to highlight the role of volunteers.

Mental Health Provision: The Chief Executive of Kent and Medway Partnership Trust responded to a question about proposed mental health provision. She said that there was a need to provide mental health services in a different way and that they needed to be provided in a whole system context that also considered physical needs. The aim was to bring together services and provide them locally, although it was recognised that not all services would be provided in Medway.

Prevention Spending – A Member of the Board expressed concern that only  2% of total health and social care funding was spent on preventing people becoming ill and asked how this figure could be increased. The Programme Director said that counting prevention spending separately was not necessarily helpful as it could mask that the prevention agenda should be important for everyone. Encouraging increased preventative work was also challenging given the length of time it could take for the benefit of such work to be realised. The CCG Accountable Officer highlighted the preventative work being undertaken by the Fire Service, as mentioned in the video shown earlier in the meeting. There were opportunities for the Council and voluntary sector to work together further in relation to the prevention agenda, including issues such as smoking cessation, alcohol and substance misuse and promoting the importance of exercise. It was noted that the 2% figure for expenditure on prevention was misleading as much work in this area would not be paid for from a specific prevention budget.

The Chairman of the Board reflected that all the Members of the Health and Wellbeing Board were partners in the STP process. The statistics contained within the Case for Change document were for the whole of Kent and Medway. The Chairman was keen to see the relevant statistics specifically for Medway. There was a need to promote the Medway offer more widely. One example would be encouraging providers who were looking to establish care facilities in Medway to use local telecare solutions rather than bringing in their own providers and equipment.

A number of Board Members agreed that the Case for Change was a well presented and clear document.

Decision

The Board:

i)    Noted the update provided on the Kent and Medway Health and Social Care Sustainability and Transformation Plan and commented on the Case for Change document and the emerging service plans.

ii)  Agreed that an update on the STP should be brought to the next meeting of the Board in June 2017.